This US trial, involving 113 COPD exacerbation patients, aimed to evaluate ECCO2R's effectiveness against standard care. The study, intended for 180 patients, was prematurely stopped due to slow enrollment. Results showed no significant improvement in ventilator-free days at Day 5 with ECCO2R. Specifically, in the non-invasive ventilation stratum, ECCO2R and standard care both recorded a median of 5 ventilator-free days, while in the invasive ventilation stratum, ECCO2R resulted in slightly more ventilator-free days (2 days vs 0.25 days), but without statistical significance. Notably, ECCO2R was associated with a higher in-hospital mortality rate in the non-invasive group (22% vs 0%).